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General NPI Number Information
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NPI Number | 1588581714
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Entity Type | Individual
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Provider Name | DANIEL MORTENSON DO
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Gender | Male
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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Country | US
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Telephone | 304-388-5432
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Fax |
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Provider Business Mailing Address
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Address Line | 1336 JOHNSON RD
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City | CHARLESTON
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State | WV
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Zip | 25314-2554
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Country | US
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Telephone | 559-905-6291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ED01504
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License Number State | WV
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